Professor AJ Ireland, Professor JR Sandy BOSF Grant 2008

Chewing Gum and Orthodontic pain relief

BOSF Grant 2008

Primary investigator

Prof AJ Ireland, Prof JR Sandy, Dr A Jordan, Dr P Ellis, Dr R Bradley, Prof P

Pictured back row (left to right) Nick Wenger, Scott Deacon, Paul Ewings, Jonathan Sandy, Tony Ireland, Rebecca Bradley.  Front row: Nikki Atack, Helen Griffiths, Pamela Ellis, Matthew Moore


The aim of this prospective randomised trial was to compare the use of chewing gum against conventional analgesia (ibuprofen) for the relief of orthodontic pain, following both initial wire placement and the first routine archwire change. In addition the effects of anxiety on pain relief and chewing gum use was investigated as were the effects of chewing gum use on bond failure.

Subjects and settings

The study was performed in 9 orthodontic units in the South West of England and 1000 patients aged 11-16 years who were undergoing full upper and lower fixed appliance therapy were recruited into the trial. 


Just prior to bond up each patient was asked to complete an anxiety questionnaire.  They were then randomly allocated into either the sugar free chewing gum group or ibuprofen group. Following the bond up and wire placement they were then instructed to use either sugar free chewing gum or ibuprofen (according to group) as required to provide pain relief. Patients then completed a pain questionnaire which recorded pain levels and what was taken to relieve the pain for the next three days. This was repeated at the next appointment where the archwire was changed, with patients remaining in their initial chewing gum or ibuprofen group. Bond failure was recorded up until the appointment after the initial archwire change.


The pain questionnaire response rates were good at approximately 84% and 83% following appliance placement and 70% and 71% following the first archwire change (chewing gum group and ibuprofen group). The primary outcome was similar for the two groups: mean pain 4.31 in the experimental (chewing gum) group and 4.17 in the control (ibuprofen) group, difference 0.14 (95% confidence interval -0.13 to 0.41). There was a suggestion that the relative pain scores for the two groups changed over time, with the chewing gum group experiencing slightly more pain on the day of bond-up and less on the subsequent 3 days. However, the differences were not of clinical significance.  There were no significant differences for the period following archwire change. The reported use of ibuprofen was less in the chewing gum group than in the control ibuprofen group. Following appliance placement the mean number of occasions ibuprofen was used was 2.1 in the chewing gum group and 3.0 in the ibuprofen group. Following archwire change the analogous figures were 0.8 and 1.5 occasions.  Following both appliance placement and the first archwire change there was no clinically or statistically significant difference in the number of appliance breakages between the groups either following bond up (7% and 8.8%) or first archwire change (4.2% and 5.5%).


The use of a sugar free chewing gum may reduce the level of ibuprofen usage but has no clinically or statistically significant effect on bond failures


A comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances; a multi-center randomised controlled trial. AJ Ireland, P Ellis, A Jordan, R Bradley, P Ewings, N E Atack, H Griffiths, K House, M Moore, S Deacon, N Wenger, V Worth, E Scaysbrook, J R Sandy. American Journal of Orthodontics and Dentofacial Orthopedics (In Press)

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